Tubularization of the gastric pouch helps sustain weight loss after transoral outlet reduction for post-Roux-en-Y gastric bypass weight recurrence

Abstract

Background Traditional transoral outlet reduction (TORe) is a minimally invasive endoscopic approach focused on reducing the aperture of the gastrojejunal (GJ) anastomosis, while the tubular transoral outlet reduction (tTORe) consists of tabularization of the distal pouch utilizing an O-shape gastroplasty suturing pattern. The primary aim of this study is to compare the short-term weight loss between TORe and tTORe. Methods Retrospective analysis of a prospectively maintained database was conducted at a tertiary care bariatric center of excellence. The study included patients with history of Roux-en-Y gastric bypass (RYGB) who had an endoscopic revision by TORe or tTORe and had follow-up data in their electronic medical record. The primary outcome was % total body weight loss (%TBWL). Results A total of 128 patients were included (tTORe=85, TORe=43). At 3 and 6 months, the tTORe and TORe cohorts presented similar %TBWL (3 months: 8.5 ±4.9 vs. 7.3 ±6.0, p=0.27 and 6 months: 8.1 ±7.4 vs. 6.8 ±5.6, p=0.44). At 9 months, there was a trend towards greater weight loss in the tTORe cohort (9.7 ± 8.6% vs. 5.1 ± 6.8%, p=0.053). At 12 months, the %TBWL was significantly higher in the tubularization group compared to the standard group (8.2 ±10.8 vs. 2.3 ±7.3%, p=0.01). Procedure time was significantly different between both groups (60.5 vs. 53.4 minutes, p=0.03). The adverse events rate was similar between groups (8.2% vs. 7.0% for tTORe and TORe, respectively, p=0.61). Conclusion The tTORe enhances efficacy and durability of the standard procedure without adding significant procedure-related risks.